As part of our "patient empowerment program" we provide a full in-depth consultation with a consultant pharmacist whereby we will evaluate your symptoms, the saliva test of your hormones (if performed), and any other pertinent laboratory results via phone consult. We then make an assessment and write a clinical consult note that includes recommendations for natural, bio-identical hormone replacement that you can provide to your doctor. If your doctor will not prescribe after reviewing our recommendations, we will provide you with a referral to a physician in your area that will prescribe bioidentical hormones. The fee for this program is $25 for the first 15 minutes, then $2 per minute thereafter for the initial consult. This fee is 100% reimbursed to you if you use our compounding pharmacy to have your prescriptions filled.

Bioidentical Hormone Consultation

For patients seeking access to bioidentical hormone therapy and customized service, Bellevue Pharmacy has created the Patient Empowerment Program, a bioidentical hormone therapy consultation service to offer women and men an ongoing hormone management program. This program allows us to:

• Evaluate by means of completed patient history form and personal or phone consultation
• Measure baseline hormone levels through Aeron Laboratory saliva testing service
• Customize hormone therapy and acquire a prescription from a U.S. licensed physician
• Prepare customized bioidentical hormone therapy protocol from Bellevue Pharmacy for therapy
• Monitor and maintain individualized therapy through continuing consultation and saliva testing.

After a completing a patient history form and phone consultation with one of our hormone consultant pharmacists, followed by salivary hormone testing and analysis, a therapy can then be discussed and a customized prescription can be requested from your physician.

Each patient approves all charges before proceeding to the next step.

STEP ONE:

Complete the Patient History Forms online, or download the forms in PDF format then print and fax or mail the completed forms to Bellevue Pharmacy, 1034 S. Brentwood Boulevard, Suite 102, St. Louis, MO 63117 (local fax: 314-727-2830 / toll free fax: 800-458-9182.)

• Women's Online Patient History Form
• Women's Printable Patient History Form (PDF Download / 9 pages / 221k)
• Men's Online Patient History Form
• Men's Printable Patient History Form (PDF Download / 6 pages / 60k)

STEP TWO:

We believe it is very important to utilize laboratory tests of hormone levels in our assessment of your hormonal status, and to incorporate this information into our recommendations. We encourage you to complete saliva testing, although we will review blood tests if you have the appropriate tests available. For women, we generally recommend testing Estradiol, Progesterone, Testosterone and DHEA. For men, we recommend testing Testosterone, Estradiol and DHEA. You can order this test from our website at the following link: www.bellevuerx.com/hormone/lab.asp

The saliva hormone test results will be mailed to you. When your saliva test results are received, Bellevue Pharmacy will contact you to schedule a consultation with one of our pharmacists to discuss a bHT protocol designed for you.

This test can be ordered without your doctor's signature if you are from one of the following states:

• Alaska
• Colorado
• Delaware
• Indiana
• Kansas
• Louisiana
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• New Hampshire
• New Mexico
• Ohio
• Oklahoma
• South Dakota
• Texas
• Utah
• Vermont
• Virginia
• Washington
• Washington DC
• West Virginia
• Wisconsin

If you do not live in one of the above listed states, or want this testing to be billed to your insurance, you must have your physician authroize the test.

With your physician's autorization, Aeron Lifecycles Laboratory can bill the following insurance plans: Blue Cross/Blue Shield, United Health Care, and Pacificare.

STEP THREE:

Our recommendations will be emailed to you for discussion with your physician. The last page of our recommendations include a fax back sheet for your physician's approval. Alternatively, new prescriptions can be phoned, faxed or mailed to our attention. We will compound and ship your prescriptions from Bellevue Pharmacy once your physician approves the prescription.

STEP FOUR:

As a patient of our pharmacy, you may receive a once a month complimentary follow-up consultation with a consultant pharmacist when your prescription refills are due to evaluate your progress. Additional consultations will be charged at $2.00 per minute. After being stabilized on your customized prescription, we recommend follow-up saliva hormone testing and analysis after 3 months symptom-free treatment and annually thereafter.

If you would like to enroll in our consultation service, please return to Step I above and follow the directions provided or click here.